In 1988, gunshot wounds were the eighth leading cause of
unintentional injury deaths among persons in all age groups in the
United States and the third leading cause of such deaths among
children and teenagers aged 10-19 years (1). From 1982 through
1988, 3607 children and teenagers aged 0-19 years died from
unintentional firearm-related injuries, constituting 32% of all
unintentional firearm-related deaths. Of those, 81% occurred among
10-19-year-olds. This article describes a case report of an
unintentional firearm-related death of a teenager and summarizes an
analysis of demographic and regional differences in unintentional
firearm-related mortality among children and teenagers from 1982
through 1988.
Case Report

In a large metropolitan area in the southern United States,
two brothers were playing in their home with two friends while the
boys' parents were at work. Initially, they played in the boys'
bedroom using the bunk beds and bedspreads to build "forts"; they
also engaged in gun play using plastic toy guns. Later, they
divided into two teams to play hide-and-seek. One of the boys, a
13-year-old, hid in his parents' bedroom where he found his
father's 12-gauge shotgun stored under the bed. The shotgun was
kept in the house for protection; the boy did not know it was
loaded. When his friend, also aged 13 years, entered the room
looking for him, the boy who was hiding inadvertently discharged
the gun, killing his friend.
Analysis of National Mortality Data

Demographic and regional differences in firearm-related
mortality were examined using mortality data compiled by CDC's
National Center for Health Statistics. Unintentional
firearm-related deaths were identified by the International
Classification of Diseases, Ninth Revision, code E922.
Classification of counties as metropolitan and nonmetropolitan is
based on metropolitan statistical areas designated by the U.S.
Office of Management and Budget in 1982.

For males aged 10-19 years, the unintentional firearm-related
death rate was 10 times that for females (2.0 per 100,000 versus
0.2 per 100,000 children). Males aged 15-19 years were at higher
risk (2.4 per 100,000) than were males in any other age group. The
risk for dying from an unintentional gunshot wound was similar for
black and white children and teenagers aged 10-19 years.

Children and teenagers living in the South * were at greatest
risk for dying from an unintentional gunshot wound; those living in
the Northeast ** were at lowest risk (Table 1). Within regions,
white males aged 15-19 years were at greatest risk in the South; in
all other regions, death rates were highest for black male
teenagers. Overall, children and teenagers living in
nonmetropolitan regions were more than twice as likely to die from
an unintentional gunshot wound as those living in metropolitan
areas; however, the rate ratio in nonmetropolitan and metropolitan
areas was 1.4 for black males aged 10-14 years and 1.1 for black
males aged 15-19 years (Table 2).

Editorial Note

Editorial Note: Despite recent declines in unintentional
firearm-related mortality (1,2), such injuries continue to
disproportionately affect youth nationwide. Unintentional
firearm-related injuries are also a major cause of morbidity. For
example, a recent report by the General Accounting Office (GAO)
estimated that, in 10 U.S. cities during 1989 and 1990, the ratio
of nonfatal to fatal unintentional gunshot wounds was 105 to 1 for
all age groups combined (3). Although the findings of the GAO
report cannot be generalized to the entire United States, they
underscore the public health impact of unintentional
firearm-related injuries.

The high rates of unintentional firearm-related mortality for
children and teenagers living in southern and western regions of
the country are consistent with the findings of previous reports
(1). Although most reports have demonstrated a higher death rate
for those living in rural areas (1,4), one study in Cleveland,
Ohio, found rates were higher in urban areas than in the suburbs
(5).

The findings in this report indicate that, although death
rates of unintentional firearm-related injuries were generally
higher for children and teenagers living in nonmetropolitan areas,
death rates for black males in metropolitan areas approached those
in nonmetropolitan areas. Risk factors, such as access to firearms
and per capita income, may have a differential impact on
unintentional firearm-related mortality. For example, the
availability of firearms has been directly associated with
unintentional gunshot wounds (5), and the relation between per
capita income of the area of residence and unintentional
firearm-related mortality varies inversely (1).

Reduction of morbidity and mortality from unintentional
firearm-related injuries among children and teenagers must
emphasize limiting access to loaded weapons. Specific behavioral
characteristics associated with adolescence, such as impulsivity,
feelings of invincibility, and curiosity about firearms, place
adolescents at particularly high risk for firearm-related injuries
(6).

One of the national health objectives for the year 2000 is to
reduce by 20% the proportion of households with inappropriately
stored weapons (objective 7.11) (7). This objective is consistent
with the findings of several studies indicating that most
unintentional firearm-related deaths involving children occur at a
residence (4,8,9) and involve inappropriately stored weapons (9).
Appropriate storage should include locked and separate storage of
weapons and ammunition. In Florida and California, legislation has
been enacted to make adults legally responsible for inappropriate
storage.

Modifying firearms and ammunition to render them less lethal
has also been advocated as a prevention strategy (1,10). The
addition of child-proof safety devices would prevent children aged
less than 6 years from discharging a firearm, and the use of
loading indicators could prevent an estimated 23% of all
unintentional firearm-related deaths (3). Regulation to control the
amount of gunpowder and the shape and jacketing of ammunition may
reduce the severity of nonfatal firearm-related injuries (1,10).

US General Accounting Office. Accidental shootings: many deaths
and injuries caused by firearms could be prevented -- report to the
Chairman, Subcommittee on Antitrust, Monopolies, and Business
Rights, Committee on the Judiciary, House of Representatives.
Washington, DC: US General Accounting Office, 1991; report no.
GAO/PEMD-91-9.

South Atlantic, East South Central, and West South Central
regions.
** New England and Middle Atlantic regions.

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